ProLongevity's Sleep Assessment
Instructions:
A. Read each question carefully

B. Answer each question as honestly as possible. Do not go back and check your answers. Your first response is usually the most accurate

C. Answer ALL questions
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What time would you get up if you were entirely free to plan your day?
15 points
Answer
5:00 – 6:29 am
6:30 – 7:44 am
7:45 – 9:44 am
9:45 – 10:59 am
11:00 – 11:59 am
Midday – 5:00 am
Clear selection
What time would you go to bed if you were entirely free to plan your evening?
15 points
Answer
8:00 – 8:59 pm
9:00 – 10:14 pm
10:15 pm – 12:29 am
12:30 – 1:44 am
1:45 – 2:59 am
3:00 am – 8:00 pm
Clear selection
If there is a specific time at which you have to get up in the morning, to what extent do you depend on being woken up by an alarm clock?
10 points
Answer
Not at all dependent
Slightly dependent
Fairly dependent
Very dependent
Clear selection
How easy do you find it to get up in the morning (when you are not woken up unexpectedly)?
10 points
Answer
Not at all easy
Not very easy
Fairly easy
Very easy
Clear selection
How alert do you feel during the first half hour after you wake up in the morning?
10 points
Answer
Not at all alert
Slightly alert
Fairly alert
Very alert
Clear selection
How hungry do you feel during the first half-hour after you wake up in the morning?
10 points
Answer
Not at all hungry
Slightly hungry
Fairly hungry
Very hungry
Clear selection
During the first half-hour after you wake up in the morning, how tired do you feel?
6 points
Answer
Very tired
Fairly tired
Fairly refreshed
Very refreshed
Clear selection
If you have no commitment the next day, what time would you go to bed compared to your usual bedtime?
10 points
Answer
Seldom or never later
Less than one hour later
1-2 hours later
More than two hours later
Clear selection
You have decided to engage in some physical exercise. A friend suggests that you do this for one hour twice a week and the best time for him/her is between 7:00 – 8:00 am. Bearing in mind nothing but your own internal “clock”, how do you think you would perform?
9 points
Answer
Would be in good form
Would be in reasonable form
Would find it difficult
Would find it very difficult
Clear selection
At what time of day do you feel you become tired as a result of need for sleep?
15 points
Answer
8:00 – 8:59 pm
9:00 – 10:14 pm
10:15 pm – 12:44 am
12:45 – 1:59 am
2:00 – 3:00 am
Clear selection
You want to be at your peak performance for a test that you know is going to be mentally exhausting and will last for two hours. You are entirely free to plan your day. Considering only your own internal “clock”, which ONE of the four testing times would you choose?
10 points
Answer
8:00 – 10:00 am
11:00 am – 1:00 pm
3:00 – 5:00 pm
7:00 – 9:00 pm
Clear selection
If you got into bed at 11:00 pm, how tired would you be?
10 points
Answer
Not at all tired
A little tired
Fairly tired
Very tired
Clear selection
For some reason, you have gone to bed several hours later than usual, but there is no need to get up at any particular time the next morning. Which ONE of the following are you most likely to do?
10 points
Answer
Will wake up at usual time, but will NOT fall back asleep
Will wake up at usual time and will doze thereafter
Will wake up at usual time but will fall asleep again
Will NOT wake up until later than usual
Clear selection
One night you have to remain awake between 4:00 – 6:00 am in order to carry out a night watch. You have no commitments the next day. Which ONE of the alternatives will suit you best?
10 points
Answer
Would NOT go to bed until watch was over
Would take a nap before and sleep after
Would take a good sleep before and nap after
Would sleep only before watch
Clear selection
You have to do two hours of hard physical work. You are entirely free to plan your day and considering only your own internal “clock” which ONE of the following times would you choose?
10 points
Answer
8:00 – 10:00 am
11:00 am – 1:00 pm
3:00 – 5:00 pm
7:00 – 9:00 pm
Clear selection
You have decided to engage in hard physical exercise. A friend suggests that you do this for one hour twice a week and the best time for him/her is between 10:00 – 11:00 pm. Bearing in mind nothing else but your own internal “clock”, how well do you think you would perform?
10 points
Answer
Would be in good form
Would be in reasonable form
Would find it difficult
Would find it very difficult
Clear selection
Suppose that you can choose your school hours. Assume that you went to school for five hours per day and that school was interesting and enjoyable. Which five consecutive hours would you select?
15 points
Answer
5 hours starting between 4:00 – 7:59 am
5 hours starting between 8:00 – 8:59 am
5 hours starting between 9:00 am – 1:59 pm
5 hours starting between 2:00 – 4:59 pm
5 hours starting between 5:00 pm – 3:59 am
Clear selection
At what time of the day do you think that you reach your “feeling best” peak?
15 points
Answer
5:00 – 7:59 am
8:00 – 9:59 am
10:00 am – 4:59 pm
5:00 – 9:59 pm
10:00 pm – 4:59 am
Clear selection
One hears about “morning” and “evening” types of people. Which ONE of these types do you consider yourself to be?
12 points
Answer
Definitely a “morning” type
Rather more a “morning” type than an “evening” type
Rather more an “evening” type than a “morning” type
Definitely an “evening” type
Clear selection
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